Les œsophagites à éosinophiles

Eosinophilic esophagitis is a chronic immune mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologic evidence of eosinophilic inflammation of the mucosa. It is one of the most prevalent esophageal diseases which can manifest by vomiting, atypical regurgitations, feeding difficulties in young children and by heart burn, dysphagia, nighttime cough and food impaction in older children and adolescent. Pathogenesis is not totally understood, genetic inheritance is observed and the disease is strongly associated with atopy. The diagnosis can be made only by endoscopy with biopsies obtained from multiples places in the esophagus. The presence of greater than 15 eosinophils per high-powered field is necessary to confirm the diagnosis. Allergy testing has poor correlation to disease activity. When the diagnosis is suspected, proton pump inhibitor-responsive esophageal eosinophilia should be eliminated by a 2-months proton pump inhibitor test before a new upper endoscopy. If the diagnosis is confirmed, both medication and dietary therapy treatment should be considered. Dietary elimination can induced clinical and histological remission and is better tolerated in young children. Several forms of elimination diet are possible: the use of an elemental diet with a strict amino acid-based formula, eliminating the six most common food allergens (milk, eggs, wheat, soy, nuts, shellfish) or selectively eliminating particular foods from the diet. Another management consists to use swallowed, topical corticosteroids. Theses treatments are effective at reducing mucosal eosinophil counts and probably at limiting submucosal fibrosis. Other therapies like biologics or immunosuppresses are currently limited.